Internationalization of the Macedonian wine exporters

The thesis investigates the internationalization process of the Macedonian wine producers and the challenges they face along their international path. The aim of the thesis is to describe, explain and understand how Macedonian wine producers internationalize. The thesis focuses particularly on the role of networks on the international growth of the wine producers from Republic of Macedonia. In order to provide a better understanding on the internationalization process of the Macedonian wine producers the thesis presents an integrated conceptual framework by integration of the traditional and network approaches to internationalization, the integrative model of small firm internationalization, the motivating and hindering factors and the key factors influencing the process. To achieve the aim, the thesis focuses on the wine subsector in Macedonia. An exploratory multiple case study approach is adopted in order to provide better understanding of the process based on the international experiences of six wineries from Macedonia. The findings showed that the Macedonian wine producers commence international activities soon or right after the establishment of the wineries. The exports of bottled wine are concentrated in the regional markets while the exports of bulk wine are concentrated in Germany. The initial and ongoing export activities are motivated as a result of the limited domestic market and, to a lesser extent, as a reaction to the opportunities that arise from the foreign markets in form of unsolicited orders. In the later stage of the export development the producers of bottled wine are motivated to internationalize by proactive factors, such as knowledge about foreign markets and representative product, in addition to the limited domestic market. However, the findings showed that the proactive motivation and approach in looking for new market opportunities, in this case, do not reflect in a proactive expansion to new foreign markets as the wineries are concentrated on few key markets where the wine is exported as bulk or bottled with lower prices, indicating that the expansion to new markets depends from other factors too. It was identified that those are mainly factors that originate from the domestic environment that reflect on the export activities of the wineries in the foreign environment, and are thus beyond their control. Examples are: lack of country image outside the regional markets, underdeveloped support industry, lack of governmental support and unregistered wine regions in the EU as a country specific factor that influences the development of image of Macedonia as a producer of quality wine. Personal and business networks play a significant role on the export activities of the Macedonian wine producers as they provide them with information and knowledge about foreign market opportunities and in some cases initiate establishment of new contacts and business relationships. However, not all of the wineries are aware of the role of the business and personal relationships on their internationalization process. In addition, the wine associations, except for one, are not perceived as an instrument that creates international opportunities for the wineries. The level of presence of the Macedonian wine producers in the foreign markets is not sufficient to meet the quantity production potential of the wineries. Thus further expansion on these markets and to new foreign markets and the development of stable business relationships, would allow for utilization of their unused production capacities, thus higher profitability, which will enable them to invest in new technology and equipment or innovation. Moreover, it will be beneficial to the overall Macedonian economy and employment in the viticulture regions

Uticaj aterosklerotskih promena i faktora rizika na kognitivni status pacijenata sa asimptomatskom stenozom karotidnih arterija

The presence of carotid atherosclerosis is a potential risk factor for disorder of cognitive functions. This was demonstrated by studies that examined the relationship between carotid atherosclerosis and cognitive disorder. Carotid artery stenosis and thickening of the intima-media tissue (IMT) reflect different degrees of severity of the atherosclerotic process. Carotid artery stenosis is defined as atherosclerotic narrowing of the proximal part of the internal carotid artery, 70% in severe cases and 50% in moderately severe cases. The presence of lacunar infarcts of the brain is associated with an increased risk of dementia. Vascular risk factors and inflammatory mechanisms are involved in the atherosclerotic process, so determining the inflammatory activation can also be useful in the risk assessment in patients with carotid artery disease. In our study, the following results were obtained with respect to the correlation of risk factors, carotid stenosis and cognitive disorder. The study is prospective, by analyzing a total of 180 patients divided into 3 groups, aged 50-70 years: 1. Patients with stenotic changes of varying degrees but without symptoms (no transient ischemic attack or brain infarction). 2. A group of patients with symptomatic stenotic changes (transient ischemic attack or brain infarction). 3. Control group of patients with headache and vertiginous disorders with normal carotid artery finding. The presence of hypertension, diabetes, hypercholesterolaemia, and circulating levels of inflammatory markers (Tumor necrotic factor alpha, C reactive protein, fibrinogen and sedimentation leucocyte formula) was evaluated. Ultrasound examination was used as a method to determine the carotid arteriosclerosis. Cognitive functions will be assessed using the Addenbrooke’s cognitive examination (ACE-R) test. Computed tomography of the brain was performed on receipt and after a period of 24-72 hours of admission, the size and location of the acute ischemic lesion would be analyzed. Nuclear magnetic resonance of the brain was made over a period of 6 months in all patients. Asymptomatic carotid stenosis increases the risk of cognitive impairment, and the severe degree of carotid stenosis right increases the risk of severe cognitive impairment about 14 times, and severe carotid stenosis left increases the risk of severe cognitive impairment about 20 times

Progressive Supranuclear Palsy (PSP):An Atypical Case

Progressive Supranuclear Palsy (PSP), also known as Steele-Richardson-Olszewski syndrome, is recognized as one of the most common extrapyramidal neurodegenerative disorders, following in prevalence after Parkinson's disease. This condition typically manifests in individuals over the age of 40, with the highest frequency occurring between 60 to 65 years (M, 2018). We are going to present a case of a 63-year-old female patient with difficulties with walking difficulties and sudden falls. According to her medical history, the issues began three years earlier. She also mentioned incidents of dropping objects she held and suffering a multiple falls especially when rising from a chair, causing her to fall backward. Her (initial) neurological examination revealed impairment of the upward gaze. No bulbar symptoms. Mild dysarthria. Bilateral dysdiadochokinesis. Brisk tendon reflexes. Bilateral positive Babinski sign. Impaired tandem walk, it was notable that she was walking with extended legs on a wide basis. Reduction of the synkinetic movements of the arms. Retrocolis was seen due to neck dystonia. Her MRI showed atrophy of the mesencephalon-“the hummingbird sign”. Diagnostic scales were used to distinguish the diagnosis according to the clinical phenotype, the interpretation of the score was in favor of PSP.She was started on Levodopa/Carbidopa, later COMT inhibitor was added but no therapeutic response was seen. On later follow ups she presented with gradual worsening of her cognitive and motor symptoms. Soon she developed orthostatic hypotension. She ended up in a wheelchair 2,5 years after her diagnosis and treatment, or roughly 5,5 years after the initial symptoms. Synucleinopathies and taupathies are characterized by distinct patterns of regional atrophy in the brain, leading to differences in the involvement of specific brain nuclei and resulting in variations in the affected neurotransmitter systems. In synucleinopathies (Peng C, 2018 Jan;) (Uemura N, 2020 Oct;), the primary focus of neurodegeneration is typically observed in the substantia nigra, brainstem, and limbic system, whereas tau-related neurodegeneration is predominantly localized within the frontal lobe structures and their connections to thebasal ganglia. Midbrain atrophy is a well-established feature of Progressive Supranuclear Palsy (PSP). The distinct brainstem shape observed in MRI images of PSP patients, characterized by a reduced midbrain/pons ratio, has been coined as the "hummingbirdsign" (Tsuboi Y, 2003) (Paviour DC, 2005). In contrast, when examining patients with MSA using conventional 1.5 T MRI, abnormalities may include atrophy in the lower brainstem, middle cerebellar peduncles (MCPs), cerebellum, and pons putaminal rim sign" (Thi Thuong Doan MD, 2023) (Alster P, 2022 Feb) (T., 2020 Apr;). In the field of atypical parkinsonism, it becomes evident that there are considerable overlaps in symptom presentations, making the diagnosis of a patient particularly challenging (Jecmenica-Lukic M, 2014 Aug;). This challenge is compounded by the fact that a definitive diagnosis typically relies on histological evidence, such as the presence of Lewy bodies in neurons for Parkinson's Disease (PD), glyal cytoplasmic inclusions of alpha-synuclein in astrocytes for Multiple System Atrophy (MSA) (Gregor K Wenning, 2004), or the existence of tau-positive astrocytes in the mesencephalon and brain cortex (PSP). Therefore, careful observation and the chronological tracking of symptoms, along with the patient's response or lack to response to dopaminergic therapy, become crucial factors in the diagnostic proces

Iron-deficiency anemia as a precursor to cerebral venous sinus thrombosis: A case report

Background and aims: : Cerebral venous sinus thrombosis (CVST) poses a rare yet severe neurological challenge, with multifactorial etiology encompassing prothrombotic conditions, infections, trauma, medical procedures, hormonal factors, inflammatory disorders, dehydration, malignancies, and rare inherited disorders. This case report explores the association between iron deficiency anemia and the development of CVST, shedding light on the non-specific symptoms. Methods: A 41-year-old female presented with: headache, dizziness, nausea, and vomiting. Examination revealed impaired consciousness, left-sided hemiplegia, and brisk reflexes. Diagnosis of CVST was made with computed tomography (CT) and computed tomography angiography (CTA). A comprehensive assessment, including blood count and iron studies, was conducted to evaluate the patient's iron-deficiency anemia. The case was initially managed with anticoagulation therapy and two units of packed red blood cells. Results: Imaging studies displayed bilateral subarachnoid hemorrhage, intracerebral hematomas, and a filling defect in the superior sagittal sinus. Laboratory results indicated iron-deficiency anemia and thrombocytosis. Subsequent CT scans revealed hyperdense hemorrhagic changes, persistent SAH, and intracerebral hematomas. Physiologically, iron deficiency induces a prothrombotic state through increased platelet aggregation, alterations in clotting factor function, and impaired fibrinolysis. Additional links include endothelial dysfunction, elevated homocysteine levels, and reduced nitric oxide bioavailability. Conclusions: This case underscores the significance of recognizing iron deficiency as a significant contributor to a hypercoagulable state in the context of CVST. The interplay of iron in physiological processes, coupled with its deficiency, heightens the susceptibility to thrombotic events. Recognition and management of iron deficiency anemia are crucial in mitigating the risk of complications associated with CVS

Central Nervous System Tuberculosis- Case Report

Mycobacterium tuberculosis is the leading cause of morbidity and mortality worldwide. Tuberculosis is the second most common cause of death due to an infectious agent worldwide after COVID-19 infection. Central nervous system tuberculosis (CNS-TB), accounts for approximately 1% of all cases of tuberculosis, and the most common clinical presentation is tuberculous meningitis (TBM). Tuberculosis of the central nervous system is a devastating disease that, even under appropriate antituberculin therapy, leads to high mortality rate. In this paper we present a case report of a patient in whom the disease begins slowly, progressively and chronically, with the initial clinical manifestation of dementia syndrome. Usually, TBM presents with a subacute progressive febrile illness. In 2 to 3 weeks defines meningitis phase with headache, meningismus, vomiting, mild confusion. Rare is the atypical presentation of CNS TB, as in our case. During the hospitalization, brain magnetic resonance was performed with suspicious finding for neuroinfection, Due to the suspected finding of magnetic resonance imaging, a lumbar puncture was performed and the cerebrospinal fluid was sent for analysis for specific causes, including Mycobacterium tuberculosis. Correct diagnosis and therapy in these patients are a challenge for neurologists

A brief review of curcumin loaded nanoparticles

Curcumin, the yellow extract derived from the plant Curcuma Longa, exhibited numerous therapeutic applications against wide range of chronic diseases such as diabetes, pancreatitis, arthritis, neurodegenerative diseases and various types of cancer. The first isolated curcumin was generated in 1815, from the rhizome of Curcuma longa L. by Vogel and Pelletier, and in 1910 it was identified as dipheruloilmethane [1,7-Bis(3-methoxy4-hydroxyphenyl)-1,6-heptadiene-3,5-dione], classified in the group of polyphenol compound

Influence of the Type and Amount of Liver Resection on the Survival of the Patients with Colorectal Metastases

INTRODUCTION: Colorectal liver metastases have a poor prognosis, and only 2% have an average 5-year survival if left untreated. Despite radical resection, the average five-year survival is between 25% and 44%.AIM: To explore the experience of the Clinic in the treatment of colorectal liver metastases, comparing it with data from the literature and based on the comparison to determine the influence of the type and extensity of resection survival after radical surgical treatment of patients.METHODS: This is a retrospective study. The study comprised the period between 01.01.2006 to 31.12.2015. It included a total of 239 cases, of whom: 179 patients underwent radical interventions, 5 palliative and 55 patients underwent explorative interventions due to liver metastases.RESULTS: Radical resection of liver metastases has the impact of the patient survival, and the survival is the smallest in the patients with left hemihepatectomy and the longest in the patients with bisegmentectomy. But no specific technique and the number of resected segments influenced the survival of patients with colorectal liver metastases.CONCLUSION: In patients with colorectal liver metastases only resection has potentially curative character. The type and amount of liver resection has no influence of the survival

Unraveling the complexity: A case report on spinal dural arteriovenous fistula

Spinal Dural Arteriovenous Fistulas (SDAVFs) represent a distinctive category of spinal vascular malformations, characterized by abnormal connections between arteries and veins within the spinal cords duramater. This rare condition, often overlooked, can lead to severe morbidity if left untreated. In this case report we are going to discuss a 52-year-old male who presented with a month-long onset of lower extremity weakness, gait disturbance, and urinary/stool incontinence, emphasizing the complexities in SDAVF diagnosis and underscoring the significance of early intervention.On examination, he exhibited an inability for active movements in his right arm and both legs, global muscle hypotonia, dysphonic speech, and inability to walk. Sensibility testing revealed transverse sensory loss at Th6-Th7 levels bilaterally, and reflexes were hypoactive with a positive Babinski response. No meningeal signs were noted, and sphincter control was lost. The rest of the physical examination was within normal ranges. Neuroimaging was performed.MRI showcases spinal cord edema and dilated and tortuous perimedullary veins on the cervical and proximal toracal segment, notably concentrated on the right side. Simultaneously, angiography delineates the presence of a spinal dural arteriovenous fistula (AVF), originating predominantly from the meningeal branches of the vertebral arteries, with a pronounced emphasis on the right side.The effects of SDAVFs manifest as spinal cord congestion and edema, with impact on spinal cord function and development of avascular necrosis. This progression leads to irreversible dysfunction. Timely intervention in SDAVFs through prompt endovascular embolization or surgical procedures hold promise for alleviating neural damage and positive recovery process.Keywords:Spinal Dural Arteriovenous Fistulas, Vascular malformation, Endovascular embolization

Factors Influencing Recurrence Rate and Survival of Patients with Colorectal Metastases after Liver Resection

BACKGROUND: Early recurrence implies low percentage of long survival, whereas the opportunity for re-resection in selected patients represents optimal treatment with long survival. The total 5-year survival rate after hepatectomy is up to 50%, with a number of factors that are independent clinical predictors of long survival. AIM: This study aims to analyze the patient’s data from the clinic of general and hepatobiliary surgery in Aleksandrovska Hospital in Sofia, Republic of Bulgaria, in the treatment of patients with colorectal metastases of the liver and to determine the survival factors in those patients. MATERIALS AND METHODS: A retrospective study was conducted between of January 1st, 2006 and December 31st, 2015. A total of 239 patients were included: 179 patients were treated with radical operation, 5 with palliative intervention, while 55 operative explorations were performed. RESULTS: The type and the extent of resection do not affect the occurrence of local recurrence. The size, number, and metastase localization do not affect the occurrence of intrahepatic recurrence but showed characteristics of significant predictors in cumulative and mean survival. CONCLUSION: Metastases type, number and localization and metastases in lymphatic nodes and other organs were determined as predictors of long survival of patients with colorectal metastases after resection

The Influence of Resection Size and Pringle Maneuver on Operating Time and Intraoperative Bleeding in Patients with Colorectal Metastases in the Liver

BACKGROUND: The extent of the resection, whether clamped or non-clamping resection is factor that influences the operating time and intraoperative bleeding, the development of modern techniques for vascular control and resection, and determine of lesser blood loss, morbidity, and mortality. AIM: The aim of this study was to determine the experience of General and Hepatobiliary Surgery Clinic at Aleksandrovska Hospital Sofia, Republic of Bulgaria in the treatment of patients with colorectal metastases in the liver and to compare literature reports on the influence of the extent of resection and Pringle maneuver (IPM) on operating time and perioperative bleeding. MATERIALS AND METHODS: This retrospective study covers the time period from January 01, 2006, until December 31, 2015. A total of 239 patients were included, from which: 179 patients were treated with radical surgery, 5 with palliative intervention, and 55 were subjected on operability exploration. RESULTS: The use of the IPM for vascular control insignificantly influenced the prolonged operative time, while intraoperative blood loss was significantly lower in patients with Pringle <15 min. There was no association between IPM and resection type, while intraoperative blood loss and operating time were significantly greater in patients with major resection. CONCLUSION: Resection size is directly proportional to operating time and perioperative blood loss, but it does not significantly influence perioperative morbidity. The IPM does not influence operating time, while blood loss is significantly lower in the group of patients with Pringle <15 min